Medical/Dependent Care Reimbursement Program Claim for Security Flex 125 Program®

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Download: Instructions

Use this form to request medical expense or dependent care reimbursement.

By Mail

Security Flex 125
P.O. Box 75066
Topeka, KS 66675
United States

Overnight Delivery

Security Benefit
Mail Zone 600
One Security Benefit Place
Topeka, KS 66636
United States

By Fax

866.477.6526

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You may also email your form to [email protected]